ER trips necessary, group arguesNews added by Benefits Pro on May 24, 2012
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By Kathryn Mayer

Though reports have showed trips to the emergency room are costly and sometimes unnecessary, the majority of Americans don’t seem to think so. And the American College of Emergency Physicians is standing behind them.

A new poll conducted by Harris Interactive on behalf of ACEP finds most (70 percent) of Americans say they oppose efforts by insurance companies to deny payment for emergency visits when patients believe they are having medical emergencies, but after examination are diagnosed with non-urgent medical conditions.

As for their reasoning behind visiting the ER, most respondents (85 percent) with regular medical providers who sought emergency care said they could not have waited to see their regular providers.

"No matter how we slice and dice the data, the results always say the same thing: People come to the ER because they feel they need to be there,” says ACEP President David Seaberg. “No patient should be self-diagnosing his or her medical condition. They cannot distinguish between discomfort that is a minor problem and discomfort that could be a killer. That is the emergency physician's job.”

The ACEP argues that private health plans have promoted “misleading reports” about emergency patients seeking care for nonurgent medical conditions.

“These flawed reports only look at final diagnoses—not the symptoms the patients came in with,” the organization said in a news release. “In addition, many health insurance plans communicate with their beneficiaries not to seek care unless they know they are having medical emergencies. California, Iowa, New Hampshire, Tennessee, Washington and other states have been seeking to cut back on Medicaid emergency payments because of the state budget deficits brought on by the financial crisis.”

In Washington State, the state Medicaid office was set to implement a zero tolerance policy to deny payment for Medicaid emergency patients. Denials would have been based on a list of 500 final diagnoses the state deemed to be non-urgent. For example, a broken foot that turns out to be a sprain might not be covered by Medicaid. After an outcry from physician and other groups, including ACEP and the Emergency Medicine Action Fund, Governor Chris Gregoire suspended the plan.

“We need to remain vigilant, but this was an important victory, not only for emergency patients in Washington state, but for everyone,” said Dr. Wes Fields, chair of the Emergency Medicine Action Fund. “Other states and health plans were watching closely to see what happened in that state.”

Only 8 percent of emergency visits are for nonurgent medical conditions, according to the Centers for Disease Control and Prevention. The CDC also says that nonurgent does not mean unnecessary, because care is still needed within 2 to 24 hours.

Originally published on BenefitsPro.com
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